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What it means: Each year the President prepares and submits to Congress a budget, outlining his spending and policy priorities for the coming federal fiscal year. Accompanying his budget are narrative explanations from each federal agency which present to Congress, specifically the House and Senate Appropriations Committees, the rationale behind the proposed increases or decreases in spending and/or any suggested changes in policy. These “budget justifications” or “Congressional Justifications” – CJs – also include information about spending for the current federal fiscal year, the prior federal fiscal year, and the upcoming “request” year. The CJs typically provide updates regarding agency programs, initiatives, projects, and activities and report on the status of requests that Congress has made of the agencies in the previous year’s appropriations measure.

“The NIH Congressional Justification (“CJ”) provides the Senate and House Appropriations Committees detailed estimates and justifications for research and research support activities (infrastructure, administrative, etc.) that NIH would anticipate funding at the President’s Budget Request level.”

“Head Start (+$1.65 billion) – The FY 2014 request for the Head Start program is $9.6 billion, an increase of $1.65 billion from the FY 2012 enacted level. These funds will allow Head Start programs to serve approximately 1,053,000 children by providing new opportunities for working parents to enroll their infants and toddlers in high quality early learning and development programs through the Early Head Start – Child Care Partnership proposal. The Budget supports implementation of new regulations that require low-performing grantees to compete for continued funding. Funding is requested to minimize the disruption of services to Head Start children and families during the transition period to new Head Start provider. The FY 2014 request focuses on improving program quality and ensuring that funds are directed towards the organizations most capable of providing high quality early education that can put children on a path to school success and opportunity.”

Several subcommittees of the House of Representatives have posted their deadlines for receiving Members’ programmatic and language submissions for consideration in the FY 2015 Appropriations bill. Submissions are to be delivered electronically at http://appropriationssubmissions.house.gov beginning on February 26, 2014. Most subcommittees have posted deadlines in late March – early April. If a subcommittee has not yet indicated a deadline, Dear Colleague letters with Member Submission instructions will be posted as soon as they have been circulated. To view the entire list, please click here.

Also known simply as a Dear Colleague, this is a type of letter sent by a member(s) of either the House or Senate to other members of that chamber of Congress. Typically, a Dear Colleague asks for members of Congress to support an issue, cosponsor/support legislation, or sign a letter in support of an issue or bill. Dear Colleague letters are an internal Congressional advocacy tool to help make Members of Congress aware of issues, garner additional support, and then seek a particular action either by fellow Members of Congress, the White House, or a federal agency. The letters can be sent electronically or hard copy and advocacy organizations often work with elected officials to have Dear Colleague letters circulated on their issues of concern and priority.

Election year politics already have arrived at the Capitol. Members of the House and Senate in both parties have their eyes on November 4th and are putting forward agendas and proposals to position themselves favorably in the eyes of the electorate. Look and listen for a lot of rhetoric—and possibly some action—on jobs and the economy. With a significant number of Democratic Senate retirements and numerous competitive races, conventional wisdom is that control of the Senate is in play and that Republicans have a solid chance of taking the chamber in the November election. Pundits agree that the House remains solidly in Republican control and the Democrats will remain in the minority for the next two years.

With the budget deal struck by Senator Patty Murray (D-WA) and Representative Paul Ryan (R-WI) late last fall, much of the Congressional work on the budget and federal appropriations already has been predetermined for the year. Treasury Secretary Jack Lew recently announced the nation will hit its debt ceiling on February 27th; so before the deadline, the Congress is expected to enact a measure to increase the nation’s borrowing authority without the previous political jockeying and drama.

Senate Finance Committee Chairman Max Baucus (D-MT) was confirmed as U.S. Ambassador to China late last week—causing a Senatorial game of musical chairs with respect to the chairmanship of numerous committees. The Senate Finance Committee, which has tax policy writing authority, will soon be led by Ron Wyden (D-OR), who has expressed an interest in rewriting the tax code. Changes he wishes to make include increasing the standard deduction, using the tax code to incentivize businesses to invest overseas earnings in domestic infrastructure, and bringing closer in line the taxation of investment income and ordinary income.

The latest in the implementation of the Affordable Care Act: on Monday, February 10th the White House announced it again was modifying the requirement for businesses with between 50 and 99 employees—they now have until 2016 to provide health insurance to full-time workers (those working at least 30 hours a week) or pay a penalty. This requirement already had been delayed a year; such businesses have one more year without being subject to the mandate. Beginning this year, businesses with more than 100 full-time workers are required to offer coverage to at least 70 percent of their full-time workers or face a penalty; starting next year they must offer health care to 95 percent of their full-time workforce.

Meanwhile, Republicans in the House of Representatives are seeking to change the Affordable Care Act definition of full-time workers from 30 hours a week to 40; earlier this week, the proposal gained some momentum with three Democrats signing on as cosponsors of the measure. However, with the Democrats still in control of the Senate, at least through this calendar year, it is highly unlikely such a measure would be brought up for a vote in that chamber. Should the Republicans sweep in November, it is likely that starting in 2015, the President will be sent numerous measures related to repealing or replacing provisions of the Affordable Care Act; if such legislation is attached to other proposals, President Obama will be put in a difficult position of deciding whether or not to enact or veto them. Only time and the election will tell what the future holds with respect to the long term viability of health care reform.

Thursday, December 12, 2013, promises to be a busy day for physician groups and other stakeholders interested in Congressional action to repeal and replace the Sustainable Growth Rate (SGR) system. (Background on the SGR is available here).

The Senate Finance Committee will hold a hearing on the Chairman’s mark (available here) and the House Ways and Means Committee announced it will hold a markup of its version of the legislation (legislative language is available here and a section-by-section summary is available here). Both Committees’ actions will take place at 10 am tomorrow. Like the Energy and Commerce Committee proposal, neither the Senate Finance Committee nor the House Ways and Means Committee proposal includes any offsets.

Meanwhile, the House is considering legislation that would postpone the imposition of the SGR cuts for three months and would give physicians a 0.5% update in their Medicare reimbursement. (A copy of the legislation is available here). The three-month patch also provides for a number of Medicare extenders and would delay Medicare’s controversial new “two-midnight” policy for inpatient hospital stays.

Congress is slated to adjourn by the end of the week. While a permanent fix may not be possible in 2013, enactment of a permanent solution remains likely for 2014, particularly as CBO continues to reduce the 10 year score of the legislation (background available here).

Senate and House negotiators reached an agreement yesterday, December 10, 2013, on top line numbers for Fiscal Year (FY) 2014 and FY 2015 spending and partial replacement of the sequester cuts.

It is being reported that the “bipartisan package includes $63 billion of ‘sequester relief,’ $85 billion of total savings, and $23 billion in net deficit reduction. The agreement would set the discretionary spending level for fiscal year 2014 at $1.012 trillion, and $1.014 trillion in FY 2015.” Click here to view the Politico article.

A summary, section by section, and legislative text of the budget deal can be found here.

The House is expected to consider the proposal as early as tomorrow, Thursday December 12th. While there are rumblings in the press that some conservatives and some Democrats are not happy with the deal it is too soon to know if that is the sign of a true compromise or trouble brewing in the wings.

On Friday, December 6, 2013, the independent Congressional Budget Office (CBO) gave renewed hope for all those pushing for a permanent fix to the SGR (background information on the SGR is available here). In May, CBO estimated the 10-year score for a permanent fix (without any payment updates for physicians) would cost $139.1 billion. CBO’s latest score estimates the same policy to cost $116.5 billion. According to a footnote in the report, CBO’s revision is based in part on changes made by the Centers for Medicare & Medicaid Services (CMS) in its Medicare Physician Fee Schedule Final Rule.

CBO’s latest report comes in advance of the Senate Finance Committee markup of legislation to repeal and replace the SGR, at 10:00 am on Thursday, December 12th. In October, the Senate Finance Committee and House Ways and Means Committee released a joint discussion draft of their proposal to repeal and replace the SGR (background available here). House Ways and Means Committee Chairman Dave Camp (R-MI) issued a statement indicating his Committee is making progress on its version of legislation and may hold a hearing this week, though so far the hearing has not been formally announced. The House Energy and Commerce Committee also drafted a proposal to address the SGR, which was voted on by the Committee in July (more information available here).